<div id="inner">
    <div class="text">
        <label for="amount">
            <?php echo lang('label_inv_total') ?>
        </label>
        <samp>
            <input name="mustpay" id="mustpay" readonly="" value="<?= $total ?>" placeholder="<?php echo lang('label_inv_total') ?>" value="<?php echo form_val('mustpay') ?>" type="text" />
        </samp>
    </div>
    <div class="text">
        <label for="amount">
            <?php echo lang('label_wallet_amount') ?>
        </label>
        <samp>
            <input name="amount" id="amount" placeholder="<?php echo lang('label_wallet_amount') ?>" value="<?php echo form_val('amount') ?>" type="text" />
        </samp>
    </div>
    <div class="text">
        <label for="bank_name">
            <?php echo lang('label_wallet_bank') ?>
        </label>
        <samp>
            <input name="bank_name" id="bank_name" placeholder="<?php echo lang('label_wallet_bank') ?>" value="<?php echo form_val('bank_name') ?>" type="text" />
        </samp>
    </div>
    <div class="text">
        <label for="sender_name">
            <?php echo lang('label_wallet_sender_name') ?>
        </label>
        <samp>
            <input name="sender_name" id="sender_name" placeholder="<?php echo lang('label_wallet_sender_name') ?>" value="<?php echo form_val('sender_name') ?>" type="text" />
        </samp>

    </div>  
    <div class="text">
        <label for="account_number">
            <?php echo lang('label_wallet_account_number') ?>
        </label>
        <samp>
            <input name="account_number" id="account_number" placeholder="<?php echo lang('label_wallet_account_number') ?>" value="<?php echo form_val('account_number') ?>" type="text" />
        </samp>

    </div> 
    <div class="textarea">
        <label for="note">
            <?php echo lang('label_wallet_note') ?>
        </label>
        <samp>
            <textarea name="note" id="note" placeholder="<?php echo lang('label_wallet_note') ?>" ><?php echo form_val('note') ?></textarea>
        </samp>
    </div>
    <div class="submit">
        <input class="submit"  value="<?= lang('label_done') ?>" type="submit" />  
    </div>
</div>